Selasa, 11 Januari 2011

Dysmenorrhea (Painful Menstruation, Painful Periods)

Dysmenorrhea (Painful Menstruation, Painful Periods)
Thursday, August 12, 2010
Dysmenorrhea (Painful Menstruation, Painful Periods)
Dysmenorrhea is the syndrome of difficult menstrual flow or pain during menstruation (menses).
The dysmenorrhea is derived from the Greek words dys, meaning difficult/painful/abnormal, meno, meaning month, and rrhea, meaning flow. Its prevalence is estimated at approximately 25% of women and up to 90% of adolescents. Although it is not life-threatening, dysmenorrhea can be debilitating and psychologically taxing for many women. Dysmenorrhea is responsible for significant absenteeism from work, and it is the most common reason for school/college absence among adolescents.
It can be divided into 2 broad categories: primary and secondary.
1. Primary dysmenorrhea (spasmodic) is severe, disabling cramps without underlying illness. Primary dysmenorrhea usually begins within the first 6 months after menarche once a regular ovulatory cycle has been established. During menstruation, sloughing endometrial cells release prostaglandins, which cause uterine ischemia through myometrial contraction and vasoconstriction. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experie

2. Secondary dysmenorrhea (congestive) is cramps caused by another medical problem(s). Secondary dysmenorrhea may present at any time after menarche, but it most commonly arises when a woman is in her 20s or 30s, after years of normal, relatively painless cycles. Elevated prostaglandins may also play a role in secondary dysmenorrhea along with concomitant pelvic pathology must also be present. Common causes include endometriosis, leiomyomata (fibroids), adenomyosis, pelvic inflammatory disease(PID), use of
Features of Primary dysmenorrhea
o Almost invariably occurs in ovulatory cycles
o Onset within 6 months after menarche
o In classic primary dysmenorrhea, the pain begins with the onset of menstruation (or just shortly before) and persists throughout the first 1-2 days
o Pain is Lower abdominal/pelvic pain
o The pain is spasmodic in nature
o Low back pain
o Medial/anterior thigh pain
o May have lower abdominal pain (tenderness) on pressing
o Headache
o Diarrhea
o Nausea/vomiting
Features of Secondary dysmenorrhea
o Onset in 20s or 30s, after relatively painless menstrual cycles in the past
o is not limited to the onset of menses
o usually associated with abdominal bloating, pelvic heaviness, and back pain
o the pain progressively increases during the luteal phase until it peaks around the onset of menstruation
o Heavy menstrual flow or irregular bleeding
o Dyspareunia
o Vaginal discharge
o May feel lump (swelling) on pressing lower abdomen
o Pain may not be relieved by nonsteroidal pain killers (NSAIDs)

Risk Factors of Dysmenorrhea:
1. Earlier age at menarche
2. Long menstrual periods
3. Heavy menstrual flow
4. Smoking
5. Positive family history
6. Obesity
7. Alcohol consumption
Medication: Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that cause symptoms.
1. NSAIDs reduce prostaglandin production and are used as first-line therapy for both primary and secondary dysmenorrhea. If taken early enough and in sufficient quantity, they are extremely successful in alleviating menstrual pain.
e.g. Ibuprofen (Brufen): 400 mg 4-6 hourly daily,
Diclofenac (Tab. Voveran): 25 – 50 mg twice or thrice daily
Mefanamic Acid (Tab. Meftal): 500 mg initially, followed by 250 mg 6 hourly daily
2. Simple analgesics acetaminophen may also be useful, especially when NSAIDs are contraindicated. e.g. Tab. Crocin: 1 – 2 tab 4-6 hourly daily
3. Oral contraceptives, which block monthly ovulation and may decrease menstrual flow, may also relieve symptoms.
4. Treatment of secondary dysmenorrhea involves correction of the underlying organic cause besides using above medications for symptomatic relief.
Diet to prevent Dysmenorrhea:
1. Eat a diet rich in complex carbohydrates, like whole grains, fruits, and vegetables, but low in salt, sugar, alcohol, and caffeine.
2. Fish oil: A supplement containing 1,800 mg a day of EPA and DHA (omega-3 fatty acid ) to help prevent menstrual symptoms.
3. Take vitamin E in the form of Almond or 400 to 600 IU of vitamin E daily for five days, beginning two days before expected menstruation. Vitamin E helps to lower the production of prostaglandins that contribute to the occurrence of cramps and breast tenderness during period.
4. Add more Calcium to your diet: Take green leafy vegetables or calcium tablet 250 mg to 500 mg 4-6 hourly during menstruation. Calcium has been found to reduce both the physical and mental symptoms, occurring during menstruation by maintaining normal muscle tone of calcium-deficient hyperactive muscles.
5. Avoid foods that may cause constipation, especially in the last week of the menstrual cycle. This includes fried foods, sour foods and protein-rich pulses.
6. Lower your fat intake. High fat diets can worsen Dysmenorrhea.
7. Magnesium plays a role in controlling muscle tone and useful in preventing menstrual cramps. Take 360 mg per day of magnesium for three days beginning one day prior to start of expected flow.

Alternative treatment:
Position or posture of the body: Simply changing the position of the body can help ease cramps.
1. Fetal position: Knees pulled up to the chest while hugging a heating pad or pillow to the abdomen.
2. Cat stretch position: The woman rests on her hands and knees, slowly arching the back.
3. Pelvic tilt position: The woman lies with knees bent, and then lifts the pelvis and buttocks.
Homoeopathy for Menstrual Cramps: Homoeopathic remedies have had a repute of treating period pains and cramps efficiently. Mag Phos is a highly potent, and speedily acting for menstrual cramps. It alleviates menstrual cramps within 20 to 30 minutes of their onset. Furthermore, it reduces the intensity and frequency of the cramps with each successive period. It is especially indicated in women who have severe, spasmodic, painful cramps, associated with a slight backache.

Acupuncture: Acupuncture may be a useful therapy in the treatment of dysmenorrhea

Home remedies for Dysmenorrhea (For Painful Menstruation):
1. Apply a heating pad to your lower abdomen (below your navel). Be careful NOT to fall asleep while this device is on.
2. Take warm showers or baths.
3. Do light circular massage with your fingertips around your lower abdomen.
4. Ginger: Ginger helps in painful menstruations and heavy blood flow. Boil grounded one fresh piece of ginger in one cup of water for few minutes. You can add sugar also if you want. Drink this at least three times in a day.
5. Parsley juice: Use of parsley juice on a regular basis is very effective home remedy in cramps and in irregular menstruations. This juice can be taken with other vegetable extracts like carrot juice.
6. Raw papaya: Eating unripe papaya will help to regulate the blood flow and help in severe pain during menstruation. Raw papaya helps in proper functioning of the muscles of the uterus, which enable the proper flow of blood.
7. Sesame seeds: Half-tablespoon of powder of sesame seeds with water twice daily is very effective to reduce the pain during menstruations in anemic person.
8. Coriander seeds: Coriander seeds are very useful for menstrual pain and also controls excess blood flow. Boil half liter water with six grams (15-20) of coriander seeds. You can add sugar also if you want. Drink when it is still warm.
9. Thuja extract: Thuja extract is very effective in resolving the symptoms of primary Dysmenorrhea. Thuja is commonly known as Arborvitae or Thujas. Boil 1 to 2 leaves of Thuja tree. Strain and drink the filtrate twice daily during menstrual periods. It is safe and well tolerated in the treatment of Dysmenorrhea.
10. Lemon grass is also beneficial in painful and difficult menstruation. It can be taken in the form of a tea.
11. Asafoetida (Hing) is very useful in increasing the secretion of the female hormone, progesterone. Thus it facilitates menstruation. Fry asafetida in a little ghee and take this paste thrice daily. For a bloated feeling in the abdomen, you can have a glass of buttermilk mixed with a pinch of asafetida.
12. Marigold: Marigold is very effective in severe pain during menstruation. Take 1-2 tablespoon of marigold extract two times a day. This also regulates the blood flow during menstruation.

Myths and Facts about Menstruation:
Myth: Do not drink ice water during menstruation.
Fact: Cold water does not have any effect during menstruation.
Myth: Should not swim during menstruation
Fact: As long as women wear pads and did not feel uncomfortable, there is no restriction of swimming during menstruation.
Myth: Teenagers who have not started menstruating cannot get pregnant.
Fact: In many females ovulation starts much before menstruation so pregnancy can happen.
Myth: Don’t wash your hair when you’re menstruating.
Fact: There is absolutely no reason not to wash your hair. In fact, a nice warm bath can do a lot to relieve menstrual cramps and premenstrual tension. Just avoid cold water during your period.
Myth: You won’t get pregnant if you have sex during menstruation
Fact: Don’t count on it! Unless you’re using The Pill, an internal device, or another hormonal type of contraception, there are no safe days as ovulation can happen at any time, especially if periods aren't regular.
Myth: Menstrual cycles should always be 28 days.
Fact: The length of a normal cycle ranges between approximately 20 to 45 days with an average cycle length of 28 days.
Myth: Women are always moody, bitchy, and irrational during menstruation.
Fact: Not all women experience PMS symptoms or the same symptoms.
Myth: Virgins or young women can't use tampons.
Fact: The hymen stretches, if you want to use tampons at any time or age, you can. Virginity does not end when you use a tampon.
Myth: It’s unhealthy to have sex during your period.
Fact: Though uncomfortable in some women, there is no medical reason to avoid sexual intercourse during menstruation, even orgasm sometimes relieve cramping.

Warning: The reader of this article should exercise all precautions before following any of the method mentioned in this article and the site. To avoid any problems, it is advised that you consult a doctor. The responsibility lies solely with the reader and not with the site or the writer.
Posted by Dr Akshay at 11:53 AM

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